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Dr Noa Keren, Dr Laura Haynes, Dr Rosanna Bevan, Dr Reena Bhatt, Steve Tomlin, Dr
Ronny Cheung and Dr Alice Roueché
Evelina Children’s Hospital, Guy’s and St Thomas’ NHS Foundation trust
Summary
Results (cont’d)
We looked at prescribing standards on
Mountain ward, a general paediatric ward
which has 44 beds covering general
paediatrics, general surgery, ENT and High
Dependency Unit.
• We used a PDSA approach to improve
prescribing. Improvement is ongoing.
• Standards to be improved:
•
100%
90%
80%
70%
60%
50%
Stop date signed and dated
40%
Fluids clearly prescribed
30%
Legible writing
20%
The problem
10%
0%
• Medication errors are a common occurrence in the healthcare setting and are
the most common type of errors in paediatric medicine 1
• We know that up to 13% of inpatient paediatric prescription charts in the UK
contain a medication error 2
• A 2009 NPSA review showed that medication incidents constituted 17% of
patient safety incidents for children and 15% for neonates.3
Local Problems:
• Medicines safety is important – reference.
• Multiple patient safety issues around prescribing were highlighted by 16
prescribing related incident reports in 2014 for Mountain ward
• 15 reported as no harm, 1 low harm
• 50% to do with medication dosing
Figure 1: Prescribing standards with lowest compliance (percentages)
• Overall compliance with prescribing standards:
100%
90%
Prescribing
teaching at
induction
80%
70%
60%
•Prescribing teaching at
induction
•Introduction of prompt
cards
50%
40%
Aims
30%
20%
• Achieve 100% compliance with prescribing standards within six months
Method
•
•
•
•
•
•
•
0%
Analyse incident forms regarding prescribing on Mountain ward in 2014
Assess 5 paper drug charts per week, selected at random for each bay of the
ward
assessment categories based on national prescribing standards, trust
guidelines and errors noted in incident forms from 2014
Items assessed:
• Patient details
• Allergy box completed + signed
• Patient’s weight
• All medications signed + dated
• Appropriate dose + units for weight + route
• Stop date signed + dated
• Fluids clearly prescribed
• Legible writing
• Appropriate timings
• Pharmacy input
• Antibiotics review date charted
• Appropriate route of administration
• No duplicate prescriptions
• No issues overall
PDSA cycle approach to change
Initiate training/teaching/prompts according to errors noted
Continue to reassess drug charts weekly to assess impact of ‘intervention’
Results
• 5 charts each week were assessed over 8 weeks
• List of good things:
Item assessed
Patients’ details
Patients’ weight
No duplicates prescriptions
Appropriate dose and units for weight +
route
Legible writing
Pharmacy input
Appropriate route of administration
Appropriate timings
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10%
Percentage achieved
100%
80-100%
Figure II: Overall compliance with all prescribing standards each week (percentages)
Improvements
•Incorporating prescribing teaching and RCPCH
prescribing assessment into induction. This
involved undertaking the assessment and
getting individual feedback in person. This took
place twice; at the beginning of March and April
as charted in figure II. The first session had 11
doctors from Mountain ward and the second
had 6.
•Improvements planned:
• Targeted education sessions addressing
prescribing problem areas
• Prompt cards
• Posters on the ward – targeting a different
standard each month according to most
recent results
Prompt Cards for prescribing fluids in
children
Learning and next steps
• Prescribing standards are generally very high
• Focus education on aspects done less well –documentation of when medications
are stopped, fluid prescriptions and legible writing
• Further input from pharmacy and sharing learning objectives with other teams
within the hospital and the wider paediatric community.
• Continue to re-assess prescribing standards regularly to assess long term effects
of education and identify new areas of focus by regular review of incident forms
in the department.
References
1. Levine S, Cohen M, Blanchard N, Frederico F, Magelli M, Lomax C, Greiner G, Poole R,
Lee C, Lesko A (2001) Guidelines for preventing medication errors in pediatrics. The
Journal of Pediatric Pharmacology and Therapeutics 6: 426-442.
2. Ghaleb M, Barber N, Franklin BD, Wong I. The incidence and nature of prescribing and
medication administration errors in paediatric inpatients. Archives of Disease in
Childhood 2010; 95: 113–118.
75-100%
3. National Patient Safety Agency 2009 Review of patient safety for children and young
people. London. National reporting and Learning Service.